Where do we go from here? Exploring the future of enterprise imaging in a COVID-19 world

remote radiology

Most healthcare experts believe COVID-19 will be with us for a long time, with cases – and mitigation efforts – ebbing and flowing in regular waves. Experts also believe the “normal” we’re living in now will give way to a newer version of normal. One that weaves together aspects of both our personal and working lives before and after the pandemic.

“For example, radiologists and healthcare staff working from home,” said Fernando Martin, director, Enterprise Applications, WellSpan Health, “I don’t see that changing anytime soon.”

Martin spoke as part of a customer panel hosted by Hyland and part of the virtual Hyland Enterprise Imaging Forum, which took place August 18.

The panel, titled “Where do we go from here? Enterprise imaging and a future that includes COVID-19,” also featured Sean Enners, director, Clinical Technology-Imaging, Kaiser Permanente; Michael Toland, director of Radiology Imaging Systems, University of Maryland Medical System; and Andrew Longoria, PACS/Radiology Informatics Manager, Children’s Hospital of Philadelphia.

Assessing the current situation

radiologyAt the time of the panel, confirmed cases of COVID-19 in the U.S. topped more than 5.4 million, with national daily averages on a downward trend, indicating that a second wave of the infection was starting to recede. Now some panelists were experiencing increases in imaging volumes due to patients returning for normal procedures.

Radiology volumes at the University of Maryland Medical System (UMMS) dropped by 40 percent in March through May, Toland explained, and new cleaning procedures extended the time to completion for CT cases. “Now that case volumes are rising,” he said, “we’re working hard on scheduling so we can achieve the throughput we’d like.”

Kaiser Permanente Colorado (Kaiser) is slowly returning to normal, said Enners. In the spring, Kaiser closed most of its clinics, around 35 to 40, according to Enners, to focus on serving COVID-19 patients. Most of those clinics reopened in June with the rest returning to service in September.


For WellSpan Health (WellSpan), headquartered in York, Penn., the pandemic’s ebb and flow has demanded flexibility and adaptability.

“We cover a large geographic footprint,” said Martin. “We’re in a traffic corridor between New York, New Jersey and Maryland, so it was important to identify where patients might be coming from. We wanted to understand where we should build flex capacity.”

WellSpan mapped the flow of out-of-state patients testing positive and used that data to build capacity toward projection models. Armed with that information, WellSpan was prepared for any added capacity needs in the ICU. WellSpan also made sure it deployed the right imaging equipment where it was needed most.

“From a pediatric perspective, we didn’t have the high number of COVID-19 patients like you saw in adult institutions,” said Longoria, “but we were prepared to take on those adult patients if needed.”

Longoria’s team at the Children’s Hospital of Philadelphia was more concerned with ensuring it had the right technology and workflows in place to adapt quickly as the situation evolved.

Imaging technology flexibility critical during COVID-19

All the panelists agreed that technology adaptability and flexibility was key in the early stages of the pandemic.

“When cases started to rise in mid-March and we started shutting things down and working from home, on the IT side, it was pretty easy for us,” said Toland. “Our PACS team and system admin resources have all had the ability to work from home for some time.”blockchain

But when it came to radiology, that number leapt from about 10 percent working from home before stay-at-home orders to more than 80 percent. To ensure the PACS system could handle this new at-home capacity, Toland’s team immediately checked its VPN connectivity and bandwidth to make sure it could handle the flow.

Kaiser also shifted its imaging workforce to work-from-home status, with one rotating team member present on-site in case there is a need for physical access to a workstation or server. Prior to the outbreak, Kaiser didn’t have a formal work-from-home strategy, but was able to quickly build one. That strategy included “suped-up” laptops and high-definition monitors approved for interpretation. Kaiser also made sure it could accommodate both a possible reduction in radiology staff and an influx of work by contracting with a third-party telerad service.

WellSpan added as much flexibility as possible to manage its radiology capacity needs. The health system outfitted its team with work-from-home workstations that mirrored hospital workstations, while also ensuring imaging has both the support and connectivity it needs to get the job done. WellSpan is reducing its dependency on third-party reading services, too, by leveraging hired radiologists and giving them the flexibility required to read anytime around the clock.

Workflow changes were minimal for WellSpan, said Martin, though his team remained ready for change, whether that meant determining what services the team could provide based on personal protective equipment (PPE) availability or deploying portable imaging equipment where needed.

Teleradiology was already common at the Children’s Hospital of Philadelphia (CHOP), said Longoria. Its challenge was VPN connectivity and gaining access to images. Longoria’s team solved this by implementing hardware VPNs instead of software VPNs. That presented its own challenge, since many organizations were searching for similar equipment early on.

The hospital had to rely on the flexibility of its staff as it tested various platforms to ensure those working from home would have stable and reliable connectivity. Once locked in place, CHOP turned toward solutions that would allow digital image sharing with patients, reducing the risk of community spread by eliminating the need to visit the hospital or doctor’s office to pick up physical media.

Taking a look toward the futurethe future of medicine

All four panelists believe much of what has become normal in the last six months will evolve into our future “next normal.” They embrace the idea of a hybrid remote/on-site work model, allowing radiologists – and others – the ability to either choose the environment in which they work best or combine the two options.

To support this new hybrid model, healthcare systems will need to invest in connectivity technology.

“Can we get a gigabyte at home?” Toland asked. “That’s a decision we all have to make. We need to be ready to support users, and the right remote connectivity will allow us to do just that.”

“As we move to a longer term read-from-home model, the healthcare system as a whole is going to have to invest in solving that bandwidth issue,” Enners agreed. “It’s not something a team like mine can solve. It’s going to take commitment from organizations.”

Beyond fortifying remote work capabilities, WellSpan is exploring ways technology can assist with the diagnosis of COVID-19.

“Traditional lab testing is not as timely or as accurate as we’d like it to be, and we know imaging could provide a better diagnosis of COVID, even in asymptomatic patients,” said Martin. “We’re exploring options, like artificial intelligence, that we can embed in our infrastructure and be part of our imaging workflow, so we can flag patients who might not be showing symptoms or are presenting symptoms and we don’t want to wait several days for test results.”

Toland reminded everyone to look at the bigger picture. While many of us are working from home, our colleagues on the frontline continue working directly with COVID-19 patients.

“We have to support those efforts any way we can. We have to be mindful of that,” he said. “We have to figure out a way to help even while we’re remote.”

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Julie Clements

Julie Clements

Julie Clements is a healthcare solution marketing manager at Hyland.

... read more about: Julie Clements

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